116 LAFAYETTE STREET UNIT 202 RETURNED CERTIFIED MAIL CARD 10-22-2025 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A. Signature
■ Print your name and address on the reverse X ❑Agent
so that we can return the card to you. ❑Addressee
■ Attach this card to the back of the mailpiece, B. F, ceived y(Printed Name) C. Date of Delivery
or on the front if space permits.
1. Article Addressed to: D. Is delivery ddress different from item 1? ❑Yes
If YES,enter delivery address below: ❑No
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111111111 INIII I II II I I I ll I I I l II I I I li Il I I(I'll 3. Service Type ❑Priority Mail Express®
El Adult Signature- ❑Registered MaiIT"'
❑Adult Signature Restricted Delivery O Registered Mail Restrictee
Certified Mail® Delivery
9590 9402 8704 3310 7018 37 Certified Mail Restricted Delivery ❑Signature ConfirmationTm
0 Collect on Delivery ❑Signature Confirmation
2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery -Restricted Delivery
❑Insured Mail
9589 0 710 5270 3103 1104 9 9 O'it Restr clad Delivery
PS Form 3811,July 2020 PSN 753 Domestic Return Receipt
LISPS TRACKING#
First-Class Mail
Postage&Fees Paid
USPS
5 L Permit No.G-10
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9590 9402 8704 . 0 7018 37
United States •Sender: Please print your name,address,and ZIP+4®in this box•
Postal Service
RECEIV. p
,ram CITY OF SALEM
r BOARD OF HEALTH
OCT 2 2 2015 98 WASHINGTON ST,3'D FL
- SALEM,MA 01970
CITY OF SALEr i
BOARD OF HEAL
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